The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team will cast the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle.
The Usual Suspects
- Graham Walker F.UCEM sounds the cry ‘Peer Review is dead, long live Peer Review!’ in a fabulous post that marvels at the changes that promise to sweep through the world of emergency medicine, and the scientific pursuits that underpin clinical practice, with the rise of web resources and social media. It echoes the philosophy of The LITFL Review and riffs on themes from these LITFL posts: Time to Publish Then Filter? and The Wisdom of Crown Review. Like us, Graham sees the rise of web resources and social media as the way of the future. He also demands that academic recognition be given to those who contribute to this new arena of knowledge. No dissension from us on that one either! Hopefully, you’re aware that Graham is the creator of MDCalc and is a key player in the team behind TheNNT.com.
- Leon has unearthed some more gems this week. It’s a toss up between LITFL’s favourite amphetamine substitute (Mephedrone Review) and our favourite venomous marine beasties (Just when you thought it safe to go back to the beach…). It appears that, as always, both papers have their flaws.
- Michelle asked for help to crowd-source everyone’s favourite smartphone apps for use in EM in Need your help! Favorite medical apps — she got swamped! Meanwhile, Stella delivers a succinct approach to a sometimes thorny problem with Paucis Verbis card: Workup for first-time seizure. Also, it was great to see the first edition of The LITFL Review featured in Hot off the press: A summary of EM content in social media.
- Ever had a paediatric patient with a nasty fracture that needs reduction, but refuses to have an IV, even after your best bribery attempts and bathing them in EMLA? This problem is now a thing of the past! Amy Levine, & Tim Valeriote, examine the effectiveness of intranasal analgesia, and review the ins-and-outs of intranasal medication delivery in the ED. Also, should lay bystanders just do compressions when they come across out-of -hospital cardiac arrest victim? Christopher Carpenter takes a look at the latest research surrounding this and provides you with the answer in To breath or not to breath?.
- January’s podcast is split into two huge episodes looking at ‘Pearls and Pitfalls in Trauma’ (episode 1 & episode 2). These jam-packed episodes are presented by Dr. Dave MacKinnon and Dr. Mike Brzozowski and cover all things new and controversial in trauma — from the use of ketamine in head injured patients through to the role of permissive hypotension in multi-trauma patients.
The Rest of the Best
- Can you tell the difference between an hyper-acute STEMI, hyperkalaemia or early repolarisation? According to ECG maven Dr Stephen Smith the answer is in the Peaked T wave. Also, watch his 3 videos on the importance of doing serial ECGs and their impact on patient outcomes… Starting with this:
- At least one of the LITFL team (CN) has long believed the dangers of calcium in the patient with digoxin toxicity is overstated. EM Updates highlights a recent study on the effects of intravenous calcium in patients with digoxin toxicity. This retrospective study of 161 patients is probably the best evidence currently available on this subject. The conclusion: “among digoxin-intoxicated humans, intravenous calcium does not seem to cause malignant dysrhythmias or increase mortality”. Hmm, one wonders if there will be any changes made to the 3rd edition of the Tox Handbook?
- The lads from Vienna give us the 7 Golden Rules to becoming an expert echocardiographer, a skill that may soon be essential for doctors working in critical care settings.
- Many of us in the blogging world are sleep deprived, given the imperfect imbalance of work, play, family and online commitments. Would more sleep might makes us more productive? Dr Ves F.UCEM shares a thought provoking post with featuring a TED talk by Arianna Huffington called How to succeed? Get more sleep.
[Editorial note: I can't stand this talk!... Is TED running out of ideas worth spreading? --- Chris]
- Joe Lex’s pick of the week is a talk by Gary Gaddis on The Proper Use of Antiemetics. Gary advocates a mechanistic approach to the treatment of nausea and vomiting. Excuse a few echoes, this talk makes a lot of sense.
- Adrian Goudie presents the case of an elderly gentleman with urosepsis. He was initially unable to identify the kidneys on ultrasound… Find out why here.
- Amal Mattu, one of the giants of emergency medicine, brings you these pearls on therapeutic hypothermia from a recent study in Resuscitation:
- Therapeutic hypothermia is generally accepted as a useful intervention that should be employed in patients that are resuscitated after cardiac arrest.
- Many protocols for cooling are relatively complicated, involving endovascular catheters, cooling blankets, cooling helmets, or other devices that are expensive and not widely available.
- The cooling process can actually be fairly simple, however, with ice and cool IV fluids. The most recent study that demonstrated this used nothing more than application of ice to the groin, neck, and axillae; and administration of 4o C IVF infused at 30cc/kg at 100ml/min via two peripheral catheters. Sedation or paralysis + intubation was used as per the norm.
- Patients receiving this simple intervention were able to achieve goal temperature of 32o-34o C within 3-4 hours, and hypothermia was maintained for a full 24 hours before rewarming.
- The study shows that expensive equipment and complicated protocols are not necessary for therapeutic hypothermia.
- Colin interviews the ‘grandfather of croup’ Dr Gary Geelhoed in a podcast about the steroid saga. They cover past, present and future research surrounding the controversies in croup management.
[Editor's note: grandfather or grandmaster? I called him grandfather at work today. He seemed OK with it! --- Chris]
- Ian tells us the tear jerking tale of the death of a nursing home patient with an advance health-care directive in the emergency department. Betty’s Death shows it can be the little things that make the biggest difference to dying patients, even if it’s not how the patient had wish to die.
- Movin’ Meat puts his meat cleaver into journalism and explains why he hate’s medical journalism. He relates the story of a young child who had a bad outcome while waiting for medical care in the emergency department. His points are spot-on about journalists: how they appeal to our emotions with a ‘kiddie doing badly’ case to highlight how bad ED overcrowding is, how they tend to sensationalise and only tackle the real and important issues as an afterthought. however, the authors do give a great metaphor for explaining ED overcrowding in lay-man’s terms.
- Charlene Babcock Irvine offers a few useful pearls and pitfalls in a case of acute spinal cord injury. How do you assess motor function using the Glasgow Coma score? How can you distinguish between spinal and haemorrhagic shock? Should you give steroids?
- How do you determine a patient’s resuscitation status? It is never a simple task, and needs to made in times of high stakes. Does ‘do not resuscitate’ mean do not treat? It can be a very thin line between the two. This post on confusion and controversy about resuscitation status peers into the grey murkiness of this difficult dilemma.
Twitter Meducation News
- As featured in Emergency Medicine Tweducation, Iain Beardsell of the Southampton Emergency Medicine Education Project created some brilliant videos for web 2.0 newbies this week. They include Using Twitter for Emergency Medicine Education, Online Internet Based Learning, and a guide to Using iTunes to download Emergency Medicine Podcasts. All are well worth watching and, if you’re not already following Iain on Twitter, tweet him up here.
News from the Fast Lane
- The first edition of The LITFL Review was a rip roaring success, it exceeded all expectations by receiving 1900 visitors over the past week. However, it’s early days and the format will evolve, so feel free to make suggestions!
- The ECG library continues to take shape thanks to ECG nerd Ed Burns. The latest addition is a page on all you need to know about the PR segment and interval — it’s surprisingly riveting reading!
- Whoops, almost forget, guys Valentine’s day is fast approaching… Don’t forget to order something special for that special someone. Check out the LITFL inter-mate apparel range.
A Word from our Sponsors
The past week saw the arrival of Professor Inglebert Struvite Staghorn on the twitter scene. First the first time the general public were able to witness first hand the momentous debates that take place among the members of the UCEM Council Executive:
Addressing suggestions that there may be reprisals from the orthopedic community following the release of the UCEM Guidelines for Orthopedics, Prof Staghorn was quick to put any such concerns to rest by showing who had the upper hand:
The Final Words
“He who works with his hands is a laborer. He who works with his head and his hands is a craftsman.”
St.Francis of Assisi
“Live neither in the past nor in the future, but let each day absorb all your interest, energy and enthusiasm. The best preparation for tomorrow is to live today superbly well.”
That’s it for now… Hopefully this roundup of the world of electronic emergency medicine and critical care education for everyone helps to you deal with anyone, anything, anywhere at anytime for at least another week!
If you’d like to suggest something for inclusion in the next edition of The LITFL Review, email our roving reporter: kane AT lifeinthefastlane.com